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<br /> <br /> <br />HUD DISCLOSURE REPORT <br /> <br />PART I - APPLICANT/GRANTEE INFORMATION <br />Applicant/Grant Name <br /> <br />Address <br />City State ZIP Code <br /> <br />Phone <br /> <br />Check One <br /> <br />Initial Report Update Report <br />Federal Employer Identification Number <br /> <br />Projects Assisted/to be <br /> <br />1. Fiscal Year <br /> <br /> <br /> <br />2. Amount HUD Funds Requested/Received for this Project $ <br />3. Aggregate amount of all other assistance from HUD, State, and unit of general local <br />government for this specific project or activity that you have received and can <br />reasonably expect to receive during the Federal fiscal year the application is <br />submitted. <br />$ <br />4. Total of 2 and 3. $ <br /> <br /> <br />PART II - THRESHOLD DETERMINATIONS <br />Is the amount listed at 2 (above) more than $200,000? Yes No <br />Is the amount listed at 4 (above) more than $200,000? Yes No <br />Is this application for a specific housing project that involves other government assistance? Yes No <br /> If the answer to any question of this Part is "Yes", then you must complete the remainder of this report. <br /> <br />If the answer to all questions of this Part is "No", then you are not required to complete the remainder of this <br />report, but you must sign the Part VI certification and return Parts I, II, and VI to the Division of Community <br />Services. <br /> <br />